Provider Demographics
NPI:1477286409
Name:INTERNOSCIA, BRIELLE
Entity Type:Individual
Prefix:
First Name:BRIELLE
Middle Name:
Last Name:INTERNOSCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 HIGHWAY 35 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MANTOLOKING
Mailing Address - State:NJ
Mailing Address - Zip Code:08738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:187 HIGHWAY 35 SOUTH
Practice Address - Street 2:
Practice Address - City:MANTOLOKING
Practice Address - State:NJ
Practice Address - Zip Code:08738
Practice Address - Country:US
Practice Address - Phone:908-507-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool